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OBJECTIVE To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources. DESIGN Cluster randomised controlled trial. SETTING Five healthcare organisations in the United States and 60 affiliated practices. PATIENTS 405 patients, aged > or = 18 years, starting or(More)
BACKGROUND U.S. military ground forces report high rates of war-related traumatic stressors, posttraumatic stress disorder (PTSD), and depression following deployment in support of recent armed conflicts in Iraq and Afghanistan. Affected service members do not receive needed mental health services in most cases, and they frequently report stigma and(More)
The COOP Project, a primary care research network, has begun development of a Chart method to screen function quickly. The COOP Charts, analogous to Snellen Charts, were pretested in two practices on adult patients (N = 117) to test feasibility, clinical utility, and validity. Patients completed questionnaires containing validated health status scales and(More)
BACKGROUND Because primary care physicians (PCPs) are the initial health care contact for most patients with depression, they are in a unique position to provide early detection and integrated care for persons with depression and coexisting medical illness. Despite this opportunity, care for depression is often suboptimal. OBJECTIVE To better understand(More)
Depression in primary care is a chronic disease. As with most chronic diseases, long-term adherence to treatment plans is problematic. Evidence-based systems of care address this problem, but persistence and dissemination of systems after testing is a new problem. The three-component model for the care of patients with depression is a system of widely(More)
OBJECTIVE To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS The education(More)
BACKGROUND Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy. METHODS In a randomized controlled trial (RCT), a clinical model for depression was implemented through a strategy(More)
The Study of Outpatient Referral Patterns was conducted in 1998 to examine the nature of the communication relationship between psychiatrists and primary care physicians regarding outpatient referrals. Nationally representative psychiatrists were surveyed (N = 542) regarding their aggregate experience with outpatient referrals from non-psychiatric(More)
African-American and Hispanic women receive fewer indicated cancer early detection services than do majority women. Low rates of cancer screening may, in part, explain the disproportionately higher rates of cancer deaths in this population. The aim of this qualitative study was to explore through individual interviews the perceptions of barriers and(More)
BACKGROUND Recent studies provide new insights about strategies that improve depression outcomes. We explored the feasibility of implementing these strategies in community practices. METHODS Clinicians followed an office system approach to management of depression. There were no controls. The office system was based on established routines performed by a(More)